To treat traumatic brain injury in soldiers, take gender into account

While serving in Operation Iraqi Freedom, Sharron, a U.S Army sergeant, sustained a blunt force injury to the head during routine maintenance on an armored truck. Years later, the injury has left her with crippling side effects, including severe headaches, disorientation, memory loss, aggression, and irritability. These changes compromise Sharron's daily quality of life. An expectant mother, Sharron worries about the relationship she will have with her child.

Sharron is not alone in her experience of traumatic brain injury or "TBI." Indeed, this condition affects between 12 and 20 percent of returning veterans and has been a hot topic in the U.S. media. Despite the prevalence of this condition, we lack an understanding of how women like Sharron fare in comparison to men, according to Dr. Odette Harris, an Associate Professor of Neurosurgery at the Stanford University School of Medicine.

In previous studies of veterans with TBI, researchers have focused on pooled data comprised almost entirely of men, who make up the majority of injured veterans. To fill in this research gap, Harris has studied how these injuries specifically affects women, such as Sharron.

The result? Harris identifies significant ways the consequences of TBI are manifested differently for women and men—and she uses this data to develop treatment and policy recommendations specifically tailored to women veterans.

Brain injuries are invisible war wounds

A traumatic brain injury is caused by a blow or sudden jolt to the head. The injury blocks pathways used by the brain to send messages, which causes a temporary loss of brain functioning and is often accompanied by loss of consciousness. The U.S. military has witnessed a rise in the number of troops returning from combat with TBIs. Blasts from improvised explosive devises are the leading cause of TBIs in the military, but many troops also sustain head injuries from assaults, falls, and vehicle accidents while on duty.

There is reason to believe that there are gender differences in the outcomes for veterans with TBI because women in the military face uniquely gendered stressors.

The effects of TBI can be short or long term. TBI can impair cognitive functioning, cause emotional, mood, and behavioral changes, and generate physical symptoms such as headaches and amnesia. Because the scars from this injury are less visible than other injuries sustained during combat, TBI has been dubbed by the media as an “invisible” or “silent” wound.

The increasing numbers of veterans with TBI has led to a growth of treatment facilities and has spurred new research to better understand the condition and make recommendations for best treatment practices. The potential problem with these studies, according to Harris, is that they focus entirely on aggregated data, which is majority male. As women account for just 5 percent of TBI injuries in the military their experience is often lost as “noise” in the data set and therefore has been dismissed by researchers as outliers or random variability in the data.

According to Harris, there is reason to believe that there are gender differences in the outcomes for veterans with TBI because women in the military face uniquely gendered stressors. Women are more likely than men to be single parents and are more likely to experience gender-related harassment and sexual assault. These factors potentially complicate the effects of TBI by adding additional stress and trauma.

Harris's research focuses on women’s injuries

Rather than throwing out data related to women, Harris focused on this population exclusively. Comparing her results to that of previous researchers, Harris finds significant differences between how TBI affects women and men.

Women from Harris’s study exhibited severe symptoms at higher rates than the general population of veterans with TBI. Women are more likely to suffer from post-traumatic stress disorder, cognitive disorders and impairments, depression, anxiety, and substance abuse than the average male veteran with TBI, according to Harris. Women are also more likely to suffer from chronic pain, neurological and neurobehavioral problems, and sleep disorders. These difficulties interfere with reintegration into civilian society and lead to higher rates of unemployment and homelessness among injured women veterans.

Women are also more likely to suffer from multiple symptoms—for example depression and chronic pain. This multiplicity of symptoms makes diagnosis and treatment more difficult.

TBI disrupts women veterans’ daily lives

In order to more fully understand the personal consequences of TBI for women, Harris and her colleagues invited the women veterans from the study to share their own stories through video narratives. This video project allowed the researchers to capture the nuanced and personal experiences of the women suffering from TBI.

Sharron's story—presented as a video message to her unborn child—forms one such narrative. For Sharron, the impacts of TBI extend beyond the physical symptoms. Since her injury, Sharron feels that she has become a different person, less positive and less motivated. Daily functions have become more difficult and mood changes, irritability, and disorientation have strained her relationships.

In these video narratives other women discuss how the effects of TBI have led to problems finding and keeping jobs, substance abuse, and homelessness. For these veterans, their injuries have disrupted their lives and produced a new set of daily challenges. Harris hopes that her research and the efforts of policy makers and care providers can help improve outcomes for all veterans suffering from these devastating effects of TBI.

Meanwhile, she advises researchers take into account the stressors and additional circumstances that uniquely affect women, such as sexual harassment and pre-military traumas.

Harris also recommends that future researchers, practitioners, and policymakers consider important differences between veterans with TBI according to sex, ethnicity, and the number and severity of injuries. This goal requires that future studies specifically examine differences by these subgroups of veterans.

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Facts:

Between 12 and 20 percent of returning U.S. veterans suffer from TBI

Women with TBI are 30% more likely than men to suffer from post-traumatic stress disorder

Substance abuse is four times more common among women with TBI than men

Women with TBI are 2.7 times more likely than men with TBI to be unemployed after deployment and are almost 7 times more likely to be homeless

Dr. Odette Harris

Associate Professor

Odette Harris is an Associate Professor of Neurosurgery and Director of Brain Injury at Stanford University School of Medicine. She is the Associate Chief of Staff, Polytrauma at the VA Palo Alto Health Care System. Harris is also the Site Director/Principal Investigator of the Defense Veterans and Brain Injury Center Palo Alto site. She is a former Faculty Research Fellow at the Clayman Institute.